Therapy in the year of COVID

In the business world, there is a term – Disruptor. It is the process by which a more affordable product/service takes root innocuously at the bottom of the market, and moves up rapidly- eventually displacing established competitors. Complacent in their status quo, no one sees this coming.

This is not limited to the business world – anything that forces us to change the way we are doing things is a disruptor. And nothing has quite disrupted the world like COVID. COVID broke my stride, forced me to change my pace, to re-examine my life, and what I wanted from it. It toppled me from my comfortable perch and put me to test in every arena of my life.

I work in a Mental Health Partial Hospitalization Program, and our patients run the community meeting every day. They are supposed to state the day, date and year to orient themselves, and their peers. A patient started the meeting by saying “In this year of COVID” and the atmosphere lightened up. They were learning to accept COVID as an inevitable part of life. To say that this time has been challenging is a gross understatement. The times we live in now, will be written about and analyzed for decades.

I have been working every day, in person, throughout COVID. My journey started with extreme fear and has moved into a “new normal”. When the pandemic started my team and I were concerned. Patients were concerned too. Some dropped out right away, while others felt safe coming in as they were in a “hospital” setting. Some were so paralyzed by fear of the Pandemic that they had stopped functioning. Ironically, their path to well-being lay through their greatest fear – attending group with several other people in one room. These patients were the hardest to watch – crying, fearful of their environment, yet, at the same time, needing to come to terms with it. The rewarding part of it was seeing them get more comfortable and realistic as they left.

The countertransference that I experienced during these times was nothing like I had experienced before. It brought up feelings in me that I had not wrestled with previously. For the first time, coming to work, was a matter of life and death. For the first time, I wanted to be the object of a patient’s care, and not just a provider of it. The pandemic blurred the lines between helper and helped.

My workplace is considered an acute setting, and safety is paramount. So how does one keep safe? Keep everyone else safe?

My answer lay in boundaries. And acknowledging that I had a choice. What helped was constantly checking in to see what was in my control and what was not. I created a list of things to do: wear scrubs to work, use different shoes for work and keep them in the car, decontaminate as soon as I enter my home. My team felt better once these safeguards were in place. We also informed patients about what we could and could not do.

Patients are often cocooned in their thoughts, and are not able to break out of their ruminations to engage with the larger world. COVID shredded this cocoon and brought reality to their door step in a way that nothing else had.

Then, race erupted.

What we were seeing in our society, was reflected in the microcosm of the program. The group topics changed, needs from the program changed. How does one serve clients with different political affiliations, different beliefs? Setting boundaries around discussions, holding a safe space for all thought processes, while dealing with our own emotions became a daily occurrence.

It definitely helped to have a good team. Staff had family members with health issues, and yet they served all populations with compassion. It was difficult to do therapy with masks on. “ Are you crying?” I had to ask one of the patients, as I couldn’t really tell. I had to ask another to speak up, as the masks muffled words, hid tears. My face, one of my prominent tools in therapy, had been taken away. I tried to make up the loss through body language, exaggerated gestures, but it was not the same.

This journey is not over by any means, and there is daily speculation on what is yet to come. Yet, I am at peace in a way that I was not before.

I am happy that I went to work daily. I am grateful that I could do it. I am making use of “self” as I tell my family it will be ok. Self-care, never a priority, has now become one. (This article is a result of that- I have started to write again!). I would never have the time to just sit, just be, but I am beginning to acknowledge how important it is. I teach mindfulness to patients, and am learning to practice it in my own life, in a more intentional way. I am counting my blessings, focusing on what I have and I am truly grateful for it. 

I am fully aware that I write from a position of privilege and envy. Privilege, as I have been able to continue my employment, and envy because I could not do it from home. I am thankful for the fear that COVID brought, thankful because it tested me, forced me to expand beyond my status quo.

To borrow from business wisdom again, “The only way to avoid disruption is to create a culture that understands its value”.(https://execed.economist.com/blog/industry-trends/be-disruptor-avoid-disruption) .For therapists, the disruption is pushing us towards finding creative, sustainable adaptations of service delivery. Perhaps even a change in the understanding of what therapy encompasses. COVID has changed the landscape, and we have been tasked with creating new maps to navigate this changed territory.

Personally it has meant giving up control, giving up the world as I know it. I know it is easier said than done. But perhaps, we can start with a simple check in - What is in my control? And what is not? What do I need to change? What do I need to lean into? That is my new mantra.

````````````````````````````````````````````````